AUTHOR=Liu Yuanhui , Wang Litao , Chen Pengyuan , Dai Yining , Lin Yaowang , Chen Wei , Xu Zhengrong , Zeng Lihuan , Fan Hualin , Xue Ling , Liu Simin , Chen Jiyan , Tan Ning , He Pengcheng , Duan Chongyang 

TITLE=Risk Estimation for Infection in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Development and Validation of a Predictive Score

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 9 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2022.845307

DOI=10.3389/fcvm.2022.845307

ISSN=2297-055X

ABSTRACT=Background: Infection during hospitalization is a serious complication among patients suffered from acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI); however, there is no suitable and accurate means to assess risk. This study aimed to develop and validate a simple scoring system to predict post-AMI infection in such patients.
Methods: All ST-segment elevation myocardial infarction (STEMI) patients undergoing PCI consecutively enrolled from January 2010 to May 2016 were served as derivation cohort, and those from June 2016 to May 2018 as validation cohort, respectively. The primary endpoint was post-AMI infection during hospitalization, and all-cause death and major adverse cardiovascular events (MACE) were considered as secondary endpoints. The simplified risk model was established using logistic regression. The area under receiver operating curve  and calibration of predicted and observed infection risk were calculated.
Results: A 24-point risk score was developed, with infection risk ranging from 0.7%-99.6% for patients with the lowest and highest score. Seven variables including age, Killip classification, insulin use, white blood cell count, serum albumin, diuretic use, and transfemoral approach were included. This model achieved the same high discrimination in the development and validation cohort (C-statistic: 0.851), and revealed adequate calibration in both datasets. The incidences of post-AMI infection increased steadily across risk score groups in both development (1.3%, 5.1%, 26.3%, and 69.1%; P < 0.001) and validation (1.8%, 5.9%, 27.2%, and 79.2%; P < 0.001) cohort. Moreover, the risk score demonstrated good performance for infection, in-hospital all-cause death and MACE among these patients, as well as in patients with non-ST-elevation acute coronary syndrome.
Conclusion: This present risk score established a simple bedside tool to estimate the risk of developing infection and other in-hospital outcomes in STEMI patients undergoing PCI. Clinicians can use this risk score to evaluate the infection risk and subsequrntly make evidence-based decisions.